Secondary prevention of osteoporosis: when should a non-vertebral fracturebe a trigger for action?

The burden of non-vertebral fractures is enormous. Hip fractures account fo r nearly 10% of all fractures (and a much greater proportion in the elderly ), while wrist fractures may account for up to 23% of all limb fractures. T he best available predictors of non-vertebral fracture risk are low BMD and a tendency to fall. Hip, forearm, proximal humerus and rib fractures have all been associated with low BMD, though ankle fracture is not strongly rel ated to osteoporosis. Although clinical risk factors identify only about on e-third of postmenopausal women at increased risk of osteoporotic fracture, the occurrence of one fracture commonly predicts a second fracture. Guidel ines are presented for identifying and treating patients at risk of non-ver tebral osteoporotic fractures, especially those with a previous fracture, b ased on the algorithm recently published by the Royal College of Physicians and the Bone and Tooth Society. Prevention of falls and use of external hi p protectors may reduce the occurrence of hip fracture. Treatment options f or patients presenting with hip fracture include HRT, bis-phosphonates, and calcium plus vitamin D, and for Colles' fracture include general measures, HRT, bisphosphonates, or calcitonin plus calcium.